Download Antihistamines - Consumer Health Choices

Using the Antihistamines to Treat:
Allergies, Hay Fever,
& Hives
COMPARING EFFECTIVENESS, SAFETY, AND PRICE
Contents
2:
Our
Recommendations
3:
Welcome
6:
What Are
Antihistamines and
Who Needs Them?
9:
Choosing an
Antihistamine —
Our Best Buy Picks
14:
The Evidence
17:
5 Tips to Talking
With Your Doctor
18:
How We Picked
the Best Buy
Antihistamines
19:
Sharing this Report
19:
About Us
20:
References
Our Recommendations
This report evaluates seven newer or “secondgeneration” antihistamine medications that are widely
used to relieve the symptoms of hay fever (a type of
allergic rhinitis), hives (urticaria), and other allergies.
Studies have found these drugs to be equally effective
and generally safe, but they can be misused.
Some people who take allergy
medicines do not have allergies, so you
should see your doctor for a diagnosis
before taking antihistamines on a
regular basis.
medications. They have been shown to effectively
relieve symptoms of hay fever, hives, and other
allergies. Cetirizine is also available over-the-counter
in soft gel capsule and liquid formulations for people
who need those. You should also be aware that some
people may respond well to one antihistamine while
getting no benefit from another. So if our Best Buy
picks do not work for you, then try one of the other
antihistamines.
Your insurance might not fully cover antihistamines
or might charge you a higher than usual co-payment.
Check with your insurer or health-plan administrator
about its policy on antihistamines.
The newer antihistamines cause less drowsiness than
the older ones, which include nonprescription drugs
such as Benadryl Allergy, Chlor-Trimeton Allergy, and
Dimetapp Allergy. But the newer drugs are no more
effective than the older ones at relieving symptoms.
The monthly cost for the newer medicines varies from
about $8 to more than $200, so price might be an
important factor in your choice. This report shows
how you could save hundreds of dollars a year or
more if you currently take an expensive brand-name
antihistamine. Taking dosing convenience, cost, and
effectiveness and safety into account, we have selected
the following as Consumer Reports Best Buy Drugs:
■■ Cetirizine 10 mg tablets
■■ Loratadine 10 mg tablets
■■ Loratadine dissolving 10 mg tablets
■■ Loratadine liquid 10 mg
■■ Alavert dissolving 10 mg tablets
All are low-cost generics available without a
prescription in pharmacies and other stores that sell
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
2
Welcome
This report on a class of drugs to treat hay fever (a
type of allergic rhinitis), hives (urticaria), and other
upper-respiratory symptoms triggered by allergies is
part of a Consumer Reports project to help you find
safe, effective medicines that give you the most value
for your health-care dollar. To learn more about the
project and other drugs we’ve evaluated, go to www.
CRBestBuyDrugs.org.
Hives are red welts on the surface of the skin that are
often itchy. They are usually an allergic reaction to
food or medicine, but other substances and factors,
including stress, can trigger them too. About 20
percent of people will get hives at some point in their
lives, according to UpToDate, a physician website.
Hives are usually harmless and disappear on their
own, but if they become severe, an antihistamine
might be appropriate.
Hay fever is a type of allergic rhinitis, an allergic
reaction triggered when a person breathes in
something they are allergic to, such as dust, dander,
or in the case of hay fever, pollen. About 20 percent of
people of all ages suffer from hay fever, according to
UpToDate.
The most common symptoms include nasal
congestion, a runny nose, sneezing, and itchy and
watery eyes. Nonprescription allergy medicine is
available in drug and grocery stores. These come in
a variety of forms, including pills, liquid solutions,
nasal sprays, and skin creams. Most of the pills
contain the active ingredients chlorpheniramine
(e.g. Chlor-Trimeton Allergy); clemastine (Tavist);
brompheniramine (Dimetapp); or diphenhydramine
(Benadryl Allergy). Those drugs are considered “firstgeneration” antihistamines and have been available for
decades.
This report focuses on “second-generation”
antihistamines, which include five oral medicines and
two nasal sprays. All of the oral drugs are available as
generics, and three are available as nonprescription
over-the-counter (OTC) drugs. The nasal sprays are
available as brand-name and generic prescription
medicines. The drugs covered in this report are:
Generic
Name
Brand
Available
Name(s) as a
Prescription
Generic
Drug?
Available
as an
OTC
Drug?
Azelastine
nasal spray/
pump
Astelin,
Astepro
Yes
No
Cetirizine
Zyrtec
Yes
Yes
Desloratadine
Clarinex
Yes
No
Fexofenadine
Allegra
Yes
Yes
Levocetirizine
Xyzal
Yes
No
Loratadine
Claritin,
Alavert
Yes
Yes
Olopatadine
nasal spray
Patanase
No
No
You might recognize the brand names of the oral
medicines—Allegra, Claritin, Clarinex, Zyrtec, and
Xyzal. All have been widely advertised. And their
use has become widespread, exceeding (though not
eliminating) the use of first-generation antihistamines.
The main reason for their popularity is that they cause
less sedation and drowsiness. But those problems
can still occur when taking the newer medications,
especially at higher doses. The sedative effect of
first-generation antihistamines isn’t just annoying
or inconvenient; it can be dangerous. Studies have
consistently found that people taking the older
antihistamines are at a higher risk for auto accidents
and other incidents at home and work. Labels on these
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
3
Welcome
drugs warn people not to drive or operate machinery
while using them. In addition, most of the newer
antihistamines need to be taken just once a day while
the older ones must be taken two or more times a day
because their effect wears off more quickly.
Even so, there’s been a long-standing debate about
just how much better the newer drugs are and whether
they’re worth the extra cost. There’s no easy answer.
Most doctors advise their patients to use the newer
pills, while others think their patients do just as well
taking the older, nonprescription drugs. Some people
respond better to the older antihistamines than the
newer ones. In addition, a patient might get relief
from an older drug without much sedation, especially
if his or her symptoms are mild. Be aware, however,
that studies have found a slowed reaction time among
some people taking the older antihistamines even
when they denied feeling drowsy.
You, too, might be susceptible to the sedative effect of
older antihistamines and respond better to the newer
drugs. You might also get better symptom relief from
a newer antihistamine, though our analysis found they
aren’t any more effective than older antihistamines.
And as we have previously noted, the newer medicines
can still cause some drowsiness, especially when
higher doses are taken.
The availability of loratadine (Alavert, Claritin, and
generics), cetirizine (Zyrtec and generics), and
fexofenadine (Allegra and generics) in low-cost,
nonprescription formulations changes the cost and
risk/benefit decision, as we discuss later in this report.
In addition, some of those medications may cost as
little as $4 for a month’s supply through generic drug
programs run by major chain stores, such as Kroger,
Sam’s Club, Target, and Walmart. For an even better
bargain if you are going to be on those drugs longterm, you may be able to get a three-month supply for
as little as $10 through these programs. We note in the
price chart starting on page 12 which antihistamines
are available through these programs. Some stores,
such as CVS and Walgreens, require a membership fee
to participate and might charge higher prices. There
might be other restrictions too, so check the details
carefully to make sure your drug and dose are covered.
Most antihistamines, new and old, are also available
in combination with a decongestant, such as
pseudoephedrine. These combination products were
not included in the analysis conducted by the Oregon
Health & Science University’s Drug Effectiveness
Review Project, which forms the basis of this report, so
we do not include them in our review.
Decongestant products should be used
with caution by people with high blood
pressure, heart conditions, diabetes,
glaucoma, or prostate disease. Consult
a doctor if you are not sure whether
you should use a combination product.
If your symptoms are mild, an antihistamine might be
all you need. A doctor can also evaluate whether you
need other medicines, including prescription drugs, to
relieve your symptoms. They include:
■■ A steroid or an antihistamine nasal spray
■■ A new kind of allergy drug called a leukotriene
blocker. There are three: montelukast (Singulair and
generic); zafirlukast (Accolate); and zileuton (Zyflo)
■■ Another type of immune-modifying drug called
omalizumab (Xolair)
■■ Allergy shots (also known as immunotherapy)
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
4
Welcome
This report does not discuss those medications. If you
are taking them or have questions, consult your doctor.
Having severe allergy symptoms could be a sign of
asthma. Most people—but not all—who have asthma
also have underlying allergies. Technically speaking,
asthma is a separate condition where inflammation
and constriction of the bronchial tubes makes it
difficult to breathe. But the two conditions can go hand
in hand, especially in children and teenagers. Asthma
is more common among the young and usually
develops in childhood. But it can also strike adults.
See Table 2 on page 8 for a quick guide on how to
tell the difference. Antihistamines are not a common
treatment for chronic asthma.
Some antihistamines are occasionally used to treat
other conditions, such as motion sickness or vertigo.
In this report we focus on the use of second-generation
antihistamines only for treating hay fever, chronic
allergy symptoms, and hives.
This report was updated in July 2013.
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
5
What Are Antihistamines and
Who Needs Them?
Antihistamines work by blocking the chemical
messenger histamine, the main trigger of allergy
symptoms in the nose, airways, and skin. Histamine is a
part of the body’s natural defense mechanisms. It works
in part by widening blood vessels. That action causes
congestion and sneezing, and is also what causes red,
itchy hives on your skin after, say, a bug bite.
In people who have allergies and allergy-induced
asthma (for reasons still not entirely clear), the body’s
immune system overreacts when exposed to otherwise
harmless substances such as pollen, dust mites, mold
spores, and animal dander—it’s their skin primarily,
but also saliva and urine, that triggers the allergic
reaction. Excessive amounts of histamine are released,
causing the symptoms of an allergic reaction (see
Table 1 on page 7). Fortunately, most allergic reactions
are mild, even in people who suffer them seasonally or
have chronic allergies.
But severe allergic reactions do occur and can be lifethreatening. They are mostly reactions to insect stings,
drugs, or foods—not to mold, pollen, or other hay-fever
triggers. You might have heard the term “anaphylactic
shock.” This is a type of allergic reaction in which a
large amount of histamine is released, causing the
airways and blood vessels to constrict, which can make
breathing difficult and cause a significant drop in blood
pressure. Such reactions are medical emergencies that
generally require treatment with adrenaline injections
and intravenous corticosteroids.
The best way to prevent allergy symptoms, both mild
and severe, is to avoid the offending substance. Skin
tests can help identify what you are allergic to. But
completely avoiding them is not always possible.
The reality is that most allergy sufferers need to take
medicine, including antihistamines. A 2010 Consumer
Reports survey found that people who suffer from
allergies use a variety of measures to get relief,
including avoiding the substance they’re allergic to,
and taking both nonprescription and prescription
medications. You can read more about the survey
results and the strategies that people said were
most helpful at: http://www.consumerreports.org/
cro/2012/08/relief-from-springtime-allergies/index.htm.
Studies have found that some people who get
prescriptions for allergy medicine do not actually have
allergies. If you are taking antihistamines or other
allergy medicine regularly, you should consult a doctor
to make sure that you do have allergies, and that the
medication is appropriate for your condition.
If a doctor determines that you have an allergy,
treatment is important. Mounting evidence has found
that people with allergies are at much higher risk of
developing asthma and sinus infections (sinusitis).
And the inflammation that accompanies (and to some
degree fosters) the allergic response can damage the
respiratory system and make you more susceptible to
lung infections like pneumonia.
So, one way to think about
antihistamines, and other allergy
medicine, is that they’re not just for
symptom relief but might help prevent
the progression to more severe and
potentially life-threatening problems.
If you know you have allergies, you’re a strong
candidate for antihistamines, and are probably already
taking one. Your choices are a bit more complex if you
are not sure whether your symptoms are due to an
allergy. Tables 1 and 2 on pages 7 and 8 will help you
sort out what could be causing your symptoms.
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
6
What Are Antihistamines and
Who Needs Them?
Table 1. Do You Have Allergies or Something Else?
Location
Probably Allergies
Probably NOT Allergies
Nose and Eyes
■■ Sneezing
■■ Sore throat
■■ Teary eyes
■■ Runny nose with colored, sometimes thick, mucus discharge
■■ Itchy nose and throat
■■ Fever (slight if a cold; higher if the flu)
■■ Congestion, runny nose
■■ Cough, chest congestion
■■ Clear nasal discharge
■■ Muscle aches, feeling achy all over
■■ Cough (sometimes)
■■ Headache (sometimes)
■■ Facial pain (sometimes)
Skin
■■ Itchy, red, scaling
patches, often on
the face, elbows or
knees (eczema)
■■ Itchy, red, large
map-like patches on
the body (hives)
■■ Painful, red blisters but not itchy rashes appearing soon
after contact with offending substance (e.g. poison oak or
ivy, or caustic substance) and only where contact occurred
■■ Itchy, red rash in groin, underarms, on feet or
under breast in women (likely fungal)
■■ Silvery scaly patches that sometimes itch (may be psoriasis)
■■ Itchy skin without rash (simple dry skin)
Source: Adapted from “Is it Just an Allergy?” Consumer Reports on Health newsletter, May 2005 (Vol. 15, No. 5), page 4.
The most common mistake is thinking you have
allergies when you actually have a cold, bronchitis, a
cough, or mild flu.
If you have one of those conditions, you might
need more than an antihistamine for relief. Many
nonprescription cold and flu medicines contain an
antihistamine along with other drugs. They include
fever reducers and pain relievers such as aspirin,
acetaminophen, and ibuprofen.
You could also have a more serious condition. Some
older people who have a persistent cough, trouble
breathing, or both, might be in the early stages of
heart failure or emphysema, for example.
You should see a doctor if your symptoms continue.
Allergy-induced asthma or severe allergic reactions
don’t respond well to antihistamines alone and should
be treated with other, more potent medicines. In
particular, you should see a physician immediately if
you have serious breathing problems associated with
an allergic reaction.
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
7
What Are Antihistamines and
Who Needs Them?
Table 2. Is it an Allergy or Asthma?
Hay Fever or Allergies
Asthma
What is it?
■■ A bodily reaction to usually
harmless substances in the
environment— most often pollen,
mold, and animal dander.
■■ A condition in which the airways in the lungs
become swollen and narrow, making it difficult to
breathe and get enough oxygen in and out of your
lungs. Can be triggered by pollen, mold, dander,
smoke and air pollution, exercise, other illness,
stress, and some drugs.
Why do some
people get it?
■■ Genetic predisposition
■■ Genetic predisposition
■■ Can strike people of all ages, but
often shows up in childhood and
teen years
■■ Infection can trigger asthma
■■ Sneezing
Mild attacks:
■■ Teary eyes
■■ Feeling out of breath
■■ Itchy nose and throat
■■ Tightness in chest
■■ Congestion, runny nose
■■ Wheezing
■■ Clear nasal discharge
■■ Coughing
■■ Cough (sometimes)
Severe attacks:
■■ Difficulty breathing (sometimes)
■■ Very difficult to breath
■■ Headache (sometimes)
■■ Difficulty talking
■■ Itchy red patches on skin (hives)
■■ Skin feels as if it’s pulled tightly around ribs and neck
Main
Symptoms
■■ Usually shows up in childhood; less commonly
strikes over age 25
■■ Rapid heartbeat
■■ Must sit down, can’t walk easily
Main Treatment
Options
■■ Nasal sprays
■■ Antihistamines
■■ Inhalers and nebulizers containing short-acting
bronchodilators
■■ Decongestants
■■ Inhalers containing steroids
■■ Allergy shots
■■ Leukotriene-blocker pills
■■ Steroid pills or shots
■■ Immune-system modifiers
Source: Adapted from “Is it Just an Allergy?” Consumer Reports on Health newsletter, May 2005 (Vol. 15, No. 5), page 4.
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
8
Choosing an Antihistamine —
Our Best Buy Picks
Antihistamines are effective and generally safe. They
lessen the symptoms of hay fever, hives, and other
allergies in a majority of people, though they don’t
usually relieve symptoms entirely. And some people
get more relief than others. Antihistamines can also
become less effective with long-term use.
They all generally bring some relief in one to three
hours. And although responses vary, the drugs continue
to work for 12 to 24 hours in most people. But the nasal
sprays—azelastine and olopatadine—have been linked
to changes in taste sensations, including bitterness and
nasal discomfort. Olopatadine nasal spray has been
linked to nose bleeding, sores in the nose, and holes in
the nasal septum. Though human studies have not been
performed in pregnant women, animal studies have
found that both nasal sprays can cause birth defects, so
they should not be used by women who are pregnant or
breast-feeding.
Our analysis indicates that the tablet and liquid forms
of second-generation antihistamines—cetirizine,
desloratadine, fexofenadine, levocetirizine, and
loratadine—don’t differ in any consistent way in terms
of effectiveness, safety, or the side effects they cause.
Table 3. Summary of Evidence on Antihistamines
Generic Name
(Brand names)
Usual Adult
Dose
Proven Effective
Against Hay Fever
and Seasonal
Allergies?
Proven Effective
Against Chronic
or Perennial
Allergies?
Proven Effective
Against Hives?
(Urticaria)
Azelastine nasal spray/
pump (Astelin, Astepro)
One or two
sprays per nostril
twice daily
Yes
Yes
NA
Cetirizine (Zyrtec)
10 mg once daily
Yes
Yes
Yes
Desloratadine (Clarinex)
5 mg once daily
Yes
Yes
Yes
Fexofenadine (Allegra)
60 mg once or
twice daily, or 180
mg once daily
Yes
No
1
Yes
Levocetirizine (Xyzal)
5 mg once daily
Yes
Yes
Yes
Loratadine (Alavert,
Claritin)
10 mg once daily
Yes
Yes
Yes
Olopatadine nasal
spray (Patanase)
Two sprays per
nostril twice daily
Yes
No
NA
2
2
1. Sufficient evidence was not available for fexofenadine, although it is likely effective in treating perennial allergy symptoms.
2. NA = Not applicable; the nasal sprays are not used for treating hives.
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
9
Choosing an Antihistamine —
Our Best Buy Picks
There is only limited research that has looked at the use
of these antihistamines for treating hives. Loratadine
appears better at reducing symptoms than certirizine
in two studies. Cetirizine was more effective than
fexofenadine in one study. And levocetirizine provided
better symptom relief than desloratadine, but there was
no difference in improvements in quality-of-life.
All of the newer antihistamines cause less sedation and
drowsiness than older antihistamines. Studies indicate
that cetirizine and levocetirizine are more sedating than
loratadine and desloratadine, and that cetirizine might
be more sedating than fexofenadine. Cetirizine was
associated with an increased risk of abnormal heart
rhythm in one study, but other analyses, including a
large safety analysis by the FDA, found no increased risk.
In studies comparing the newer medications, 15 to 25
percent of people reported at least one side effect,
including drowsiness. (See Table 4 to the right.) But
three percent or fewer stopped treatment because of
side effects. Thus, as presented in Table 3 on page 9,
the newer antihistamines are quite comparable, with
none offering a distinct advantage over the others. But
their cost differs significantly. As Table 5 starting on
page 12 shows, they range from $8 per month to more
than $200 per month.
Taking effectiveness, safety, cost, and dosing
convenience into account, we have selected the following
antihistamines as Consumer Reports Best Buy Drugs:
■■ Cetirizine 10 mg tablets
■■ Loratadine 10 mg tablets
■■ Loratadine dissolving 10 mg tablets
■■ Loratadine liquid 10 mg
■■ Alavert dissolving 10 mg tablets
Table 4. Antihistamine Side Effects
Relatively Minor (usually go away in time)
■■ Drowsiness
■■ Headache
■■ Dry mouth, nose,
or throat
■■ Dizziness
■■ Nausea
■■ Hoarseness
More serious (can be annoying or
dangerous and should be reported
to a health-care professional)
■■ Rapid or pounding
heartbeat
■■ Unusual weakness
■■ Yellowing of the skin
■■ Difficulty urinating
■■ Vision problems
■■ Nervousness
■■ Stomach pain
All are low-cost generic drugs available without a
prescription in drug and food stores, and many small
convenience stores. And all are as effective and safe as
the other second-generation antihistamines.
Loratadine and cetirizine are made by several
companies, and some pharmacy chains have their own
version of it. Alavert is a “branded generic” form of
loratadine. A branded generic is a copy of an original
drug (in this case Claritin) given a special name by its
manufacturer for marketing purposes.
Cetirizine is also available over-the-counter in soft gel
capsule and liquid formulations for people who need
those.
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
10
Choosing an Antihistamine —
Our Best Buy Picks
You should also be aware that some people may respond
well to one antihistamine while getting no benefit from
another. So if loratadine or cetirizine does not work for
you, then try one of the other antihistamines.
As you can see from Table 5 starting on page 12, the
monthly costs for our Best Buys vary considerably.
That’s common for nonprescription drugs, so we urge
you to shop around for the best price, especially if
you need to take an antihistamine on a regular basis.
You might want to check online as well to see which
pharmacy chains offer the best prices on our Best Buys.
Our Best Buy nonprescription medicines are available
in 10 mg doses. Should you need to take a larger dose
to get symptom relief, try taking 20 mg of our Best
Buys (two pills or portions). (Note that this increases
your chances of having side effects, including feeling
drowsy.) If that does not work, consult your doctor. You
might need to try another class of medicine.
If you have insurance coverage for medicine, you
should check your plan’s policy on antihistamines to
find out whether antihistamines are covered and how
much you will have to pay out-of-pocket.
There is little research of good quality
on the use of second-generation
antihistamines by children. Because
of this, there is insufficient evidence
to determine if any of the secondgeneration antihistamines are more
effective at relieving symptoms or
pose greater safety concerns than the
others. But overall, the medications are
well-tolerated by them, with low rates
of withdrawal due to adverse events.
If your child needs an antihistamine to treat hay fever or
other respiratory symptoms due to allergies or hives, we
advise trying one of our Best Buy loratadine picks first.
The available evidence indicates loratadine is just as
effective as the other over-the-counter option, cetirizine,
but it is less likely to cause sedation. One study in
children found cetirizine and loratadine to be just as
effective as first-generation antihistamines for relieving
allergic rhinitis symptoms, and loratadine has been
found to provide symptom relief at 5 mg to 10 mg daily.
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
11
Choosing an Antihistamine —
Our Best Buy Picks
Table 5. Antihistamine Cost Comparison
Note: If the price box contains a , that indicates the dose of that drug may be available for a low monthly cost through programs
offered by large chain stores. For example, Kroger, Sam’s Club, Target, and Walmart offer a month’s supply of selected generic drugs
for $4 or a three-month supply for $10. Other chain stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some
programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered.
Generic Name and Dose
Brand
Name
1
Drug is a
Generic?
2
Drug is
OTC?
Usual Adult Dose
4
3
Average
Monthly
Cost
5
Azelastine nasal spray/
pump 137 mcg
Azelastine
Yes
No
Two sprays per
nostril, twice daily
$100
Azelastine nasal spray/
pump 137 mcg
Astelin
No
No
Two sprays per
nostril, twice daily
$203
Azelastine nasal spray/
pump 205.5 mcg
Astepro
No
No
Two sprays per
nostril, twice daily
$180
Cetirizine tablet 10 mg
Zyrtec
No
Yes
One
$19
Cetirizine tablet 10 mg
Generic
Yes
Yes
One
$11
Cetirizine liqui-gel capsule 10 mg
Zyrtec
No
Yes
One
$23
Desloratadine dissolving
tablet 2.5 mg
Clarinex
Reditabs
No
No
One
$237
Desloratadine dissolving
tablet 5 mg
Clarinex
Reditabs
No
No
One
$239
Desloratadine tablet 5 mg
Clarinex
No
No
One
$201
Desloratadine tablet 5 mg
Generic
Yes
No
One
$97
Desloratadine liquid 2.5 mg/5 mL
Clarinex
No
No
2.5 mg per day
$117
Fexofenadine tablet 60 mg
Allegra
No
Yes
Two
$56
Fexofenadine tablet 180 mg
Allegra
No
Yes
One
$24
Fexofenadine tablet 60 mg
Generic
Yes
Yes
Two
$36
Fexofenadine tablet 180 mg
Generic
Yes
Yes
One
$18
Fexofenadine dissolving
tablet 30 mg
Allegra ODT
No
No
Two
$128
Fexofenadine liquid 30 mg/5 mL
Allegra
No
Yes
30 mg twice per day
$14
Levocetirizine tablet 5 mg
Xyzal
No
No
One
$119
Levocetirizine liquid 2.5 mg/5 mL
Xyzal
No
No
5 mg per day
$116
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
12
Choosing an Antihistamine —
Our Best Buy Picks
Table 5. Antihistamine Cost Comparison (continued)
Generic Name and Dose
Brand
Name
1
Drug is a
Generic?
2
Drug is
OTC?
Usual Adult Dose
4
3
Average
Monthly
Cost
5
Levocetirizine tablet 5 mg
Generic
Yes
No
One
$59
Levocetirizine liquid 2.5 mg/5 mL
Generic
Yes
No
5 mg per day
$87
Loratadine dissolving
tablet 10 mg
Alavert
BG
Yes
One
$12
Loratadine dissolving
tablet 10 mg
Claritin
Reditabs
No
Yes
One
$25
Loratadine dissolving
tablet 10 mg
Generic
Yes
Yes
One
$13
Loratadine tablet 10 mg
Claritin
No
Yes
One
$22
Loratadine tablet 10 mg
Generic
Yes
Yes
One
$8
Loratadine liqui-gel
capsules 10 mg
Claritin
No
Yes
One
$26
Loratadine liquid 1 mg/5 mL
Claritin
No
Yes
5 mg per day
$15
Loratadine liquid 1 mg/5 mL
Generic
Yes
Yes
5 mg per day
$8
Olopatadine nasal spray
Patanase
No
No
Two sprays per
nostril, twice daily
$153
1.
“Generic” indicates that the drug is sold as a generic.
2.
“ Yes” means it is a generic, sold under the chemical or scientific name. “BG” means it is a branded
generic, which is a generic copy of an original drug given a special name by its manufacturer. In this
table, for example, Alavert is a branded generic. “No” means it is a brand-name drug.
3.
OTC stands for over-the-counter; “yes” means it is a nonprescription OTC drug.
4.
Frequency of use reflects recommendations on the package insert; some products can be used more or less frequently.
5.
or drugs available by prescription only, monthly costs reflect nationwide retail average prices for February 2013, rounded to the
F
nearest dollar. Data is provided by Source Healthcare Analytics, Inc., which is not involved in our analysis or recommendations. For
drugs available OTC, prices were obtained by Consumer Reports secret shoppers from five major chain pharmacies (CVS, Rite Aid,
Target, Walgreens, and Walmart) and local supermarkets across the U.S. in January 2013, and in some cases, prices were obtained by
Consumer Reports in June 2013 at the online sites of those chain pharmacies. The prices from the various stores were averaged to
yield per pill prices, which were then converted into a monthly price based on the maximum recommended number of pills per day.
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
13
The Evidence
This section presents more information on the
effectiveness and safety of antihistamines.
that both drugs improved their quality of life to a
similar degree.
This report is based on an analysis of the scientific
evidence on second-generation antihistamines. Overall,
3,121 studies and research articles were identified
and screened. From these, the analysis focused on 18
studies that provided direct evidence of comparative
effectiveness or safety.
How Safe Are Antihistamines?
How Effective Are Antihistamines?
The scientific literature comparing antihistamines
with each other is not extensive. Most of the studies
are short-term, and only a few include large numbers
of people. Taken as a whole, the evidence indicates
that the available drugs do not differ substantially
in effectiveness. With all, relief of symptoms usually
begins in one to three hours and lasts 12 to 24 hours
for most people.
The newer antihistamines appear to be quite safe.
They cause less drowsiness than older first-generation
antihistamines. But 15 to 25 percent of the people
taking an antihistamine will experience a side
effect, including drowsiness. Alcohol can exacerbate
drowsiness, so you shouldn’t drink while taking
antihistamines. And you should use caution if driving
or operating heavy or dangerous machinery while
taking an antihistamine.
In a very small number of people, antihistamines can
cause more serious reactions, such as rapid heartbeat
or heart palpitations. See a doctor if you experience
such symptoms.
The evidence is particularly weak comparing
antihistamines in people who have chronic allergies
and need to take the drugs from time-to-time all year
long and over many years. And there’s no evidence—
because the studies have not been done—that
fexofenadine (Allegra and generic) is effective in such
people, though the assumption from other evidence
and wide clinical use is that it is.
All the newer tablet antihistamines have been found
to be effective against hives, but there is very little
evidence comparing one newer antihistamine with
another. In one study, loratadine produced a slower but
slightly more complete relief of symptoms compared
with cetirizine (Zyrtec) in the early stages. But at the
end of the study, people treated with both drugs did
not report significant differences in their responses.
In another study, levocetirizine was better for relieving
symptoms than desloratadine, but patients reported
The newer antihistamines cause
drowsiness, but studies indicate they
cause less drowsiness than two older
antihistamines, diphenhydramine and
chlorpheniramine.
Other research found that cetirizine and levocetirizine
were more sedating than loratadine and desloratadine.
There is some evidence that cetirizine is also more
sedating than fexofenadine. One observational study
found no difference in sedation between loratadine and
fexofenadine.
Two second-generation antihistamines (terfenadine
and astemizole) were removed from the market
because they led to a higher risk of potentially serious
heart problems. Some evidence suggests that there
might be a very small risk of heart problems with
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
14
The Evidence
currently available antihistamines. A large study
found that cetirizine was associated with an increased
risk of heart arrhythmias. Other research, however,
indicated that cetirizine, desloratadine, fexofenadine,
and loratadine do not pose an increased risk of
arrhythmias.
Antihistamines can interact with other medicine or
dietary supplements in ways that can be dangerous.
Be sure to tell your doctor about all other medication
you take, even if you think it might not be important.
The main drugs to be concerned about are:
■■ Antifungal medications, such as ketoconazole. They
can increase the effect of some antihistamines.
■■ Aspirin, which in large doses can cause ringing
in the ears (tinnitus), a danger sign sometimes
masked by antihistamines.
■■ Certain types of fruit juice, such as grapefruit
juice, apple juice, and orange juice. They might
make some second-generation antihistamines less
effective.
■■ Any drugs known to change the way the heart
beats, such as droperidol. They should be used
cautiously if you are taking antihistamines.
■■ Medications used to improve breathing, such
as theophylline. They may raise the risk of
antihistamines side effects.
■■ Certain antibiotics, such as erythromycin. They can
increase the effects of antihistamines.
■■ Antacids that contain aluminum or magnesium.
When taken within 15 minutes of fexofenadine,
these antacids significantly decreased the effect of
that antihistamine.
If you take an antihistamine
combined with a decongestant called
pseudoephedrine (look on the package
where the active ingredients are listed),
be aware that such products should
be used with caution by people with
high blood pressure, heart conditions,
diabetes, glaucoma, or prostate
disease.
People who take products that combine these drugs
are more likely to have side effects, such as headaches
and trouble sleeping.
Age, Race, and Gender Differences
People older than 65 and members of various ethnic
groups have been under-represented in studies
of antihistamines. The evidence is insufficient to
determine if any of the newer antihistamines are safer
or better than the others at relieving allergy symptoms
among people of any particular racial group or age.
There’s also insufficient evidence to determine if men
and women respond to the drugs differently.
But safety and side effects are a concern in different
age groups. Desloratadine (Clarinex), levocetirizine
(Xyzal), and cetirizine (Zyrtec) have been found to be
safe and effective in children as young as six months
old; evidence on the safety and efficacy of loratadine
is limited to children two years or older. Evidence on
fexofenadine, azelastine nasal spray, and olopatadine
nasal spray is limited to children six years or older.
■■ The stomach acid reducer cimetidine, which
increases the effect of azelastine nasal spray.
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
15
The Evidence
Children might experience drowsiness
to varying degrees when taking
antihistamines, and the adults
responsible for them should be alert
to this. This is especially important
when it comes to teenagers who drive,
because drowsiness can impede the
ability to operate an automobile safely.
People age 60 and older are more susceptible to the
side effects of antihistamines, especially drowsiness.
People older than 70 or so are at greater risk of falls
in general, and antihistamine-induced drowsiness can
raise that risk. The dosage of some second-generation
antihistamines (primarily Zyrtec) should be reduced in
older age and for people with kidney or liver problems.
Pregnant or nursing women should only use the
second-generation antihistamines if their doctor
agrees it’s absolutely necessary. And even then, it
should be limited to the oral and liquid formulations—
cetirizine, desloratadine, fexofenadine, levocetirizine,
and loratadine. Animal studies indicate that those
second-generation antihistamines don’t increase the
risk of birth defects. No clinical trials have been done
in pregnant women to ascertain the birth defect risk.
Azelastine nasal spray caused birth defects in mouse,
rabbit, and rat studies, and olopatadine nasal spray
has been associated with adverse effects on fetuses in
animal studies.
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
16
5
Tips to Talking With Your Doctor
It’s important for you to know that the
expensive than newer brand-name medicines, but they
are not lesser quality drugs. Indeed, most generics
remain useful medicines even many years after first
being marketed. That is why more than 75 percent of all
prescriptions in the U.S. today are written for generics.
information we present here is not meant to
substitute for a doctor’s judgment. But we
hope it will help you and your doctor arrive
at a decision about which antihistamine and
dose is best for you, if one is warranted at all,
and which gives you the most value for your
health-care dollar.
1.
Mention cost to your doctor.
Ask about older medications.
Many people (including physicians) think
that newer drugs are better. While that’s a natural
assumption to make, it’s not always true. Studies
consistently find that many older medicines are as good
as, and in some cases better than, newer medicines.
Think of them as “tried and true,” particularly when it
comes to their safety record. Newer drugs have not yet
met the test of time, and unexpected problems can and
do crop up once they hit the market. Of course, some
newer prescription drugs are indeed more effective
and safer. Talk with your doctor about newer vs. older
medicines, including generic drugs.
3.
Consider generic drugs.
Prescription medicines go “generic” when a
company’s patents on them have lapsed, usually after
about 12 to 15 years. At that point, other companies
can make and sell the drugs. Generics are much less
Another important issue to talk with your
doctor about is keeping a record of the drugs you take.
There are several reasons for this:
■■ First, if you see several doctors, each may not be
aware of medicines the others have prescribed.
Bear in mind that many people are reluctant to
discuss the cost of medicines with their doctor, and
that studies have found that doctors do not routinely
take price into account when prescribing medicines.
Unless you bring it up, your doctor may assume that
cost is not a factor for you.
2.
4.
Keep up-to-date records.
■■ Second, since people differ in their response to
medications, it’s common for doctors today to
prescribe several medicines before finding one that
works well or best.
■■ Third, many people take several prescription
medications, nonprescription drugs, and dietary
supplements at the same time. They can interact
in ways that can either reduce the benefit you get
from the drug or be dangerous.
■■ Fourth, the names of prescription drugs—both
generic and brand—are often hard to pronounce
and remember.
For all these reasons, it’s important to keep a written
list of all the drugs and supplements you take and
periodically review it with your doctors.
5.
Know the facts.
Finally, always be sure that you understand
the dose of the medicine being prescribed and how
many pills you are expected to take each day. Your
doctor should tell you this information. When you
fill a prescription at a pharmacy, or if you get it by
mail, check to see that the dose and the number of
pills per day on the bottle match the amounts your
doctor told you.
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
17
How We Picked the Best Buy
Antihistamines
Our evaluation is primarily based on an independent
scientific review of the evidence on the effectiveness,
safety, and adverse effects of second-generation
antihistamines. Physicians and researchers at the
Oregon Health & Science University Evidence-Based
Practice Center did the analysis as part of the Drug
Effectiveness Review Project, or DERP.
Consumer Reports selected the Best Buy Drugs using
the following criteria. The drug (and dose) had to:
■■ Be approved by the FDA for treating allergic
rhinitis
■■ Be as effective as any other second-generation
antihistamine
DERP is a first-of-its-kind, multi-state initiative to
evaluate the comparative effectiveness and safety of
hundreds of prescription drugs. A synopsis of DERP’s
analysis of the antihistamines forms the basis for
this report. A consultant to Consumer Reports Best
Buy Drugs is also a member of the Oregon-based
research team, which has no financial interest in any
pharmaceutical company or product.
The full DERP review of antihistamines is available at
http://derp.ohsu.edu/about/final-document-display.
cfm (This is a long and technical document written for
physicians.)
■■ Have a safety record equal to or better than other
second-generation antihistamines
■■ Have an average price for a 30-day supply that is
substantially lower than the most costly secondgeneration antihistamine meeting the first two
criteria
The Consumers Reports Best Buy Drugs methodology
is described in more detail in the Methods section at
www.CRBestBuyDrugs.org.
Additional information was extracted from www.
ConsumerReports.org, Consumer Reports, and an
article in Consumer Reports on Health. Consumer
Reports on Health is a subscription monthly newsletter
published by Consumers Union.
The prescription drug costs we cite were obtained from
a health-care information company that tracks the
sales of prescription drugs in the U.S. Prices for a drug
can vary quite widely, even within a single city or town.
The prices for prescription drugs in this report are
national averages based on sales of the drugs in retail
outlets. They reflect the retail cash price that would
be paid for a month’s supply of each drug in February
2013. Prices for nonprescription drugs were obtained
from several large drugstore chains. They reflect
average prices in January 2013.
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
18
Sharing this
Report
This copyrighted report can be freely downloaded,
reprinted, and disseminated for individual
noncommercial use without permission from
Consumers Union as long as it clearly attributed to
Consumer Reports Best Buy Drugs™. We encourage
its wide dissemination as well for the purpose of
informing consumers. However, Consumer Reports
does not authorize the use of its name or materials
for commercial, marketing, or promotional purposes.
Any organization interested in broader distribution of
this report should contact us at [email protected].
Consumer Reports Best Buy Drugs™ is a trademark of
Consumers Reports. All quotes from the material should
cite Consumer Reports Best Buy Drugs™ as the source.
©2013 Consumers Reports of United States, Inc.
About Us
Consumer Reports is an independent and nonprofit
organization whose mission since 1936 has been to
provide consumers with unbiased information on
goods and services and to create a fair marketplace. Its
website is www.consumerreports.org.
Consumer Reports Best Buy Drugs is a publiceducation project administered by Consumers Union.
These materials were made possible by the states
Attorney General Consumer and Prescriber Education
Grant Program, which is funded by a multistate
settlement of consumer-fraud claims regarding the
marketing of the prescription drug Neurontin.
The Engelberg Foundation provided a major grant to
fund the creation of the project from 2004 to 2007.
Additional initial funding came from the National
Library of Medicine, part of the National Institutes of
Health. A more detailed explanation of the project is
available at www.CRBestBuyDrugs.org.
We followed a rigorous editorial process to ensure that
the information in this report and on the Consumer
Reports Best Buy Drugs website is accurate and
describes generally accepted clinical practices. If we
find, or are alerted to, an error, we will correct it as
quickly as possible. But Consumer Reports and its
authors, editors, publishers, licensers, and suppliers
cannot be responsible for medical errors or omissions,
or any consequences from the use of the information
on this site. Please refer to our user agreement at
www.CRBestBuyDrugs.org for further information.
Consumer Reports Best Buy Drugs should not be viewed
as a substitute for a consultation with a medical or
health professional. This report and the information on
www.CRBestBuyDrugs.org are provided to enhance your
communication with your doctor rather than to replace it.
CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
19
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CONSUMER REPORTS BEST BUY DRUGS
USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVES
20